NPI | 1619467677 |
---|---|
Entity Type | Organization |
Authorized Contact | TIMOTHY GATES Nurse Practitioner 248-842-3755 |
Organization Subpart ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
363LF0000X Nurse Practitioner, Family | |
Enumeration Date | 2018-05-15 |
Last Update Date | 2020-01-17 |